Optimal Strategies for Pain Control in Elderly Patients

Optimal Strategies for Pain Control in Elderly Patients

CASE 1: A 20-year-old woman sustains
a fracture of the right
femur during a car accident. She is taken by
ambulance to the emergency department
(ED). On arrival in the ED, she is given intravenous
meperidine, which significantly relieves
her pain. The patient subsequently undergoes
surgical repair of the fractured femur and is
discharged to rehabilitation after an uneventful
hospital stay.

CASE 2: A 75-year-old woman
sustains a fracture of the
right femur during a car accident. She is taken
by ambulance to the ED. She has no significant
medical history and is otherwise healthy.
On arrival in the ED, she is given intravenous
meperidine, which initially relieves her pain.
After transfer to the medical-surgical floor, the
patient experiences tremulousness, dysphoria,
and myoclonus. Subsequently, she has a
seizure.

The injury and its treatment were identical in both cases.
What went wrong in Case 2?

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